Enrolment Form/Application for Consideration 2022

1. Child's First Name:

2. Child's Surname:

3. Date of Birth:

YYYY

4. Gender *

Female

Male

5. Religion *

6. Child's PPS Number:

7. Select the class you are enrolling your child in:

ASD Class

2nd Class

1st Class

S. Infants

J. Infants

Early Start (Morning)

Early Start (Afternoon)

8. First language spoken in the home:

9. Other languages spoken in the home:

Mother's Details:

10. Mother's Name:

11. Country of Origin:

12. Date arrived:

YYYY

13. Language(s):

14. Occupation:

15. Place of Work:

16. Email address:

17. Telephone:

18. Address *

Father's Details:

19. Father's Name:

20. Country of Origin:

21. Date arrived:

YYYY

22. Language(s):

23. Occupation:

24. Place of work:

25. Email address:

26. Telephone:

27. Address *

28. In case of emergency, who is the first Emergency Contact:

Mam

Dad

Other Emergency Contact Person - please state below in 'Other' with relationship to child and telephone number

Other (Please Specify Below)

29. Number of children in family; please state number of boys & girls.

30. Position of child in family; 1st, 2nd, 3rd etc:

31. Name & Class of Brothers/Sisters already in this school:

32. Name & class of brothers/sisters attending other primary schools:

Details of Previous School Attended

33. Last school this child attended:

34. Address of previous school:

35. School's Phone Number:

36. Last Class Attended:

37. Date of leaving previous school:

YYYY

38. Is there a custody order/legal agreement in respect of your child?

Yes

39. I understand that any misinformation may invalidate this application.

40. I accept that the ethos of this school is Catholic.

Please provide the school with the following information as soon as possible:

Proof of address (Original utility bill/bank statement)
Original birth certificate
Baptismal certificate (Catholic children only)
DSM recommendation for ASD applications.

41. Child's Roll No:

42. Class:

You are not obliged to answer any of the following, however doing so will help us support your child.

43. Does your child have any of the following difficulties/conditions? Please tick if applicable.

Allergies

Haemophilia

Epilepsy

Asthma

Separation Anxiety

Language Difficulty

Speech Delay

Other (Please Specify Below)

44. Has your child ever attended any of the following services?

Psychiatrist

Psychologist

Occupational Therapy

Play Therapy

Behaviour Therapy

Speech & Language Therapy

Assessment of Need

Other (Please Specify Below)

If yes to any of the above, please send in a copy of the Professional Report.

45. Have you concerns about your child's ability to -

Follow instuctions

Use the toilet independently

Social Skills

Interact with other children

Other (Please Specify Below)

46. Have you been informed of any development delays in your child as a result of an examination by any professional medical person, e.g Public Health Nurse, G.P etc? If yes, please give details in the Comment box below.

Yes

Comment

47. Were you informed of any behavioural issues with your child while he/she attending primary school/pre-school?

Yes

Comment

48. Child's Relevant Health/Problems/Allergies:

49. Do you give St. Patrick's JNS your consent to contact the named Pre-Schools /Primary Schools for any reason after he/she starts school in September?

Yes

50. Parent's signature:

51. Date:

YYYY

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